Articulating tool for endoscopic placement of fasteners

ABSTRACT

Various articulating tools for endoscopic placement of fasteners are disclosed. The tool can comprise a multi-angle articulating screwdriver. The tool can have an elongate shaft with an articulating driver head at a distal end. The tool can rotate the articulating driver head to drive fasteners, such as screws, to a surgical site. The articulating driver head can articulate with respect to a longitudinal axis of the elongate shaft to enable the fastener to be driven at various angle. The tool can be coupled to a powered handpiece power and can transmit torque from the handpiece to the driver head.

CROSS-REFERENCE

This application is a continuation of U.S. application Ser. No.16/783,596, filed Feb. 6, 2020, which claims the benefit under 35 U.S.C.§ 120 and 35 U.S.C. § 365(c) as a continuation of InternationalApplication No. PCT/US2018/045851, designating the United States, withan international filing date of Aug. 8, 2018, titled “ARTICULATING TOOLFOR ENDOSCOPIC PLACEMENT OF FASTENERS,” which claims the benefit of U.S.Patent Application No. 62/543,551, filed Aug. 10, 2017; U.S. PatentApplication No. 62/567,584, filed Oct. 3, 2017; and U.S. PatentApplication No. 62/590,122, filed Nov. 22, 2017. The entirety of each ofthe aforementioned applications is incorporated by reference herein.

BACKGROUND Field

This disclosure relates to an articulating tool for endoscopic placementof fasteners, such as screws.

Certain Related Art

Various surgical procedures (such as bone fracture surgeries) includeinserting one or more screws into a bone to retain a structure, such asa plate (e.g., titanium osteosynthetic plates or others) on the bone.During insertion, the screw is threaded into the bone. For example, totreat a rib fracture, a surgeon can attach a plate with one or morefixation screws to an inner surface (on the side facing the lungs) ofthe broken rib. The surgery can be performed in a minimally invasivemanner with the aid of a thoracoscope. The view from the thoracoscopecan allow visualization of the inner side of the rib cage, including thefracture site(s). Thoracoscope-assisted internal fixation of fracturedribs can be more beneficial to a patient than certain other treatments,such as analgesia and/or ventilation.

SUMMARY OF CERTAIN FEATURES

Inserting screws into a bone can be challenging due to the locationand/or orientation of the bone, the surrounding anatomical structures(for example, muscles, ligaments, tendons, blood vessel, nerves, orotherwise), and/or the shape of the bone. In certain surgicalprocedures, there can be limited access to a desired insertion locationand/or angle for the screw on the bone. Retracting the fastening tool toadjust the insertion location and/or angle may be time consuming, causetrauma to the patient, and/or be inconvenient or impractical (such aswhen a direct entry path for the fastening tool is blocked by otheranatomical structures).

An extension with flexible or elastomeric portions may aid in navigatinga driver head in the patient's body. However, the flexible orelastomeric portions may not efficiently transmit a torque sufficientfor inserting a screw into the cortex of the bone.

A rigid and/or non-flexible and/or non-elastomeric fastening tool thatcan change direction may aid in navigating a driver head in thepatient's body while also efficiently transmitting a torque. In someembodiments, such an extension (e.g., a screwdriver) can include anarticulating component that is configured to articulate at multipleangles in multiple axes. This can allow the fastening tool to adjust(e.g., bend or pivot) so as to access tight spaces, reduce a frequencyof a user readjusting the position, and/or provide a desired orientationof the fastening tool. It can be beneficial that the fastening tool canat the same time maintain sufficient torque outputs to perform theintended function (e.g., to insert a fixation screw into the bone).

It can be beneficial to have an extension with an articulating componentthat has an outer profile comparable to a standard non-articulatingfastening tool. A smaller outer profile can reduce the need for alarger-sized access portal (e.g., a trocar) and/or allow the fasteningtool with the articulating component to access spaces that are usuallyaccessible by the standard non-articulating fastening tool.

In some implementations, gearing (e.g., bevel or miter gears) canprovide improved overall range for the articulating component, such asan articulating driver head. It can be desirable to use gears andgearing mechanisms that will fit into the available space whilemaintaining sufficient torque outputs to perform the original function.

Several embodiments of an articulating tool for endoscopic placement offasteners are disclosed herein that provide one or more of theabove-described benefits, or other benefits.

Any of the structures, materials, steps, or other features disclosedabove, or disclosed elsewhere herein, can be used in any of theembodiments in this disclosure. Any structure, material, step, or otherfeature of any embodiment can be combined with any structure, material,step, or other feature of any other embodiment to form furtherembodiments, which are part of this disclosure.

The preceding summary, following detailed description, and associateddrawings do not limit or define the scope of protection. The scope ofprotection is defined by the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

The abovementioned and other features of the embodiments disclosedherein are described below with reference to the drawings of theembodiments. The illustrated embodiments are intended to illustrate, butnot to limit the embodiments. Various features of the differentdisclosed embodiments can be combined to form further embodiments, whichare part of this disclosure.

FIG. 1A illustrates a side view of an example fastening tool coupled toa handpiece and an articulating driver head shown at different angles.

FIG. 1B illustrates a front view of an example fastening tool interfaceof the handpiece.

FIG. 2 illustrates a perspective view of an example fastening tool withan articulating driver head at about 0° with respect to a longitudinalaxis of the fastening tool.

FIG. 3A illustrates a longitudinal cross-sectional view of the fasteningtool of FIG. 2.

FIG. 3B illustrates a detailed cross-sectional view of a proximalportion of the fastening tool of FIG. 3A.

FIG. 3C illustrates a side elevation view of a proximal end of thefastening tool of FIG. 3A.

FIG. 3D illustrates a perspective view of an example driver head adapterof the fastening tool of FIG. 3A.

FIG. 3E illustrates a perspective view of the driver head adapter ofFIG. 3C sectioned along a central longitudinal axis.

FIG. 3F illustrates a perspective view of an example driver head.

FIG. 4A illustrates a perspective view of an example distal portion ofthe fastening tool of FIG. 2, with support walls and an outer housingnot shown for illustration purposes.

FIG. 4B illustrates operation of an example articulating (e.g., bevelgear) arrangement of the fastening tool of FIG. 4A.

FIG. 5A illustrate a perspective view of another example distal portionof the fastening tool of FIG. 2, with the support walls and outerhousing not shown for illustration purposes.

FIGS. 5B-5E illustrate various perspective views of an example bevelgear arrangement in the fastening tool of FIG. 5A.

FIG. 5F illustrates operation of the bevel gear arrangement of FIG. 5A.

FIG. 6A illustrates a perspective view of the fastening tool of FIG. 2,with the outer housing not shown and a collet housing shown astransparent for illustration purposes.

FIG. 6B illustrates a detailed view of the distal portion of thefastening tool of FIG. 6A.

FIG. 7A illustrates a perspective view of the fastening tool of FIG. 2coupled to an articulating driver head at an acute angle with respect toa longitudinal axis of the fastening tool.

FIG. 7B illustrates a detailed view of the distal portion of thefastening tool of FIG. 7A.

FIG. 8 illustrates operation of another example articulatingarrangement.

FIG. 9 illustrates operation of another example articulatingarrangement.

FIG. 10A illustrates a top view of an example articulating geararrangement with a head substantially not tilted.

FIG. 10B illustrates a side view of the articulating arrangement of FIG.10A with a head tilted to a first angle.

FIG. 10C illustrates a top view of the articulating arrangement of FIG.10A with the head tilted to a second angle.

FIG. 10D illustrates a top view of another articulating arrangement.

FIG. 10E illustrates a side view of the articulating arrangement of FIG.10C.

FIG. 11 illustrates a perspective view of another example articulatingarrangement.

FIG. 12 illustrates a side view of another example articulatingarrangement.

FIG. 13 illustrates another example articulating arrangement.

FIG. 14 illustrates an example worm gear arrangement.

FIG. 15 illustrates an example cam and/or pin articulating arrangement.

FIG. 16 illustrates an example swash plate or angled plate articulatingarrangement.

FIG. 17 illustrates a shaft rotating mechanism configured for rotatingthe driver head.

DETAILED DESCRIPTION OF CERTAIN EMBODIMENTS

A variety of articulating tools are described below to illustratevarious examples that may be employed to achieve one or more desiredimprovements. These examples are illustrative only and not intended torestrict the general inventions presented and the various aspects andfeatures of these inventions. The phraseology and terminology usedherein is for the purpose of description and should not be regarded aslimiting. No features, structure, or step disclosed herein is essentialor indispensable.

Overview

In several embodiments, an articulating tool 1 is configured tofacilitate endoscopic placement of fasteners. For example, thearticulating tool 1 may be used to drive screws into bone during asurgical procedure. As shown in FIG. 1A, the articulating tool 1 caninclude a handpiece 10 and a fastening tool 20. The handpiece 10 can bea powered device, such as having a battery and electric motor. Thehandpiece 10 can include a grip for a user to grasp and manipulate thearticulating tool 1. The handpiece 10 can include controls (e.g.,buttons) to operate the articulating tool 1, such as to direct drivingaction, speed, and/or direction (e.g., clockwise or counter clockwise).The fastening tool 20 can be coupled to the handpiece 10, such as at aproximal end of the fastening tool 20. The fastening tool 20 can beremovably connected to the handpiece 10. In certain embodiments, thefastening tool 20 is coupled to the handpiece 10 with a quick-releasemechanism. In some embodiments, the quick-release mechanism comprises arelease button or lever on the fastening tool 20 or the handpiece 10 sothat actuating (e.g., depressing) the button or lever can release theattachment of the fastening tool 20 to the handpiece 10.

The fastening tool 20 can include an articulating driver head adapter 22at a distal end of the fastening tool 20. The adapter 22 can couple to adriver head 30 (e.g., a bit configured to engage with the head of ascrew). For example, the adapter 22 can couple to the driver head 30releasably and/or via a quick-release mechanism, such as a detent.

In several embodiments, the adapter 22 is configured to rotate. Asillustrated, the adapter 22 can be configured to rotate about a joint 26and relative to a longitudinal axis L of the fastening tool 20. Rotationof the adapter 22 can enable the position and angle of the adapter 22(and thus the driver head 30) to be adjusted, which can facilitatedriving of a fastener at a desired position and angle. In someembodiments, the adapter 22 is rotatable in one plane and/or about anaxis of rotation that is generally perpendicular to the longitudinalaxis L. In certain embodiments, the adapter 22 can rotate approximately0° to approximately 140° (such as shown in FIG. 1A), or approximately 0°to approximately 110°, or approximately 0° to approximately 90°, orapproximately 0° to approximately 45°. The fastening tool 20 can includean articulation actuator configured to adjust the angle of the adapter22. In the example shown in FIG. 1A, the articulation actuator comprisesan adjustment dial 24, such as a manually operated wheel. The actuatorcan be located away from the driver head adapter 22, such as at or nearthe proximal end of the fastening tool 20.

The handpiece 10 or the fastening tool 20 can include a driver headactuator, such as a button, thumbwheel, lever, or otherwise. Forexample, the handpiece 10 can include one or more buttons 11 thatoperates the motor, which can be operatively connected to the driverhead 30, such as to rotate the drive head 30 (e.g., clockwise and/orcounterclockwise). In some embodiments, power from the motor istransmitted to the driver head 30 through an internal shaft of thefastening tool 20 and/or through the joint 26. In some embodiments, thehandpiece 10 can include software and/or hardware for adaptivelylimiting torque applied to the driver head 30. Additional informationabout adaptive torque limiting can be found in U.S. Pat. No. 9,265,551,the entirety of which is incorporated by reference herein.

In some embodiments, such as shown in FIG. 1B, the fastening tool 20 canbe indexed to the handpiece 10 in a variety of orientations. Forexample, the fastening tool 20 can be secured to the handpiece 10 in aplurality (e.g., 2, 3, 4, 6, 8, or more) of rotational positions, suchas with mating features 15 (e.g., recesses and protrusions) in thehandpiece 10 and fastening tool 20. Rotating the fastening tool 20 to anew orientation relative to the handpiece 10 can rotate the driver head30 to a new orientation as well. This can enable the drive head 30 todrive fasteners in a variety of orientations relative to the handpiece10. In some implementations, by rotating the driver head 30, which canbe configured to articulate in one plane, through the differentorientations of the fastening tool 20, the articulating tool 1 can beconfigured to articulate in those different planes (such as being ableto articulate in a half sphere of space in which the driver head 30 canbe operated in). In various embodiments, the fastening tool 20 can bedetached from the handpiece 10, rotated relative to the handpiece 10 toa new position, then reattached to the handpiece to allow for a newrange of operation of the driver head 30.

Certain Embodiments of an Articulating Fastening Tool

Various embodiments of an articulating fastening tool 200 are disclosed.As shown in FIG. 2, the fastening tool 200 can have any of the featuresof the fastening tool 20 in FIG. 1A. For example, the tool 200 can beconfigured to couple to a body at a proximal end of the fastening tool200 and to a driver head 300 at the distal end of the fastening tool200.

The fastening tool 200 can include an elongate outer housing 202 havinga proximal portion 204 and a distal portion 206. A body couplingassembly 300 can be located at a proximal end of the tool 200. The bodycoupling assembly 300 can include a collet housing 302 coupled to theproximal portion 204 of the elongate outer housing 202. As shown inFIGS. 3A and 3B, a terminal part of the proximal portion 204 of theouter housing 202 can be received within a first cavity of the collethousing 302 and can terminate at or near a transverse wall 310. Thetransverse wall 310 can include a generally central opening configuredto allow a collet shaft 308 to pass through and freely rotate withrespect to the opening of the wall 310. In certain embodiments, thehousing 202 can be rotated relative to the handpiece 10 while connectedto the handpiece 10.

The collet housing 302 can include a second cavity on an opposite sideof the transverse wall 310 from the first cavity. The second cavity canhouse a body interface 304 that extends proximally from the collethousing 302. The collet housing 302 can be received in an opening in thehandpiece 10. This can functionally connect the tool 200 and thehandpiece 10, such as to allow the motor of the handpiece 10 to drivethe driver head 300.

As shown in FIGS. 3A-3C, the body interface 304 can include a proximallyfacing surface 318. A perimeter of the proximally facing surface 318extends radially outward from an outer surface of the collet housing302. The proximally facing surface 318 can act as a stopper for thebody, such as the handpiece 10, when installing the fastening tool 200onto the body. One or more (for example, two, three, or more)orientation features, such as dowel pins 320, can extend proximally fromthe proximally facing surface 318. The dowel pins 330 can facilitatealigning the handpiece 10 with the body coupling assembly 300. The bodyinterface 304 can include an outer groove 306 near a proximal end of theinterface 304. In some embodiments, the outer groove 306 can beconfigured to facilitate in retaining the body.

As shown in FIGS. 3A-3C, the body interface 304 can have a lumen that iscontinuous from the lumens of the collet housing 302 and the elongateouter housing 202 and configured to accommodate the collet shaft 308. Aproximal end of the collet shaft 308 can terminate inside the lumen ofthe body interface 304, which can protect the proximal end of the colletshaft 308 from external impacts. At least one (e.g., two, three, ormore) ball bearings 322 can extend between an outer wall of the colletshaft 308 and a lumen wall of the body interface 304 to facilitaterotation of the collet shaft 308 in the lumen of the body interface 304(e.g., by aiding in aligning an axis of rotation of the collet shaft 308with a longitudinal axis of the lumen of the body interface 304). Abiasing member, such as a wave washer 324, can be disposed between thetransverse wall 310 and a distal ball bearing 322 (e.g., to inhibit orprevent the transverse wall 310 from impinging on the distal ballbearing 322).

The proximal end of the collet shaft 308 can be configured to couplewith a handpiece drive shaft, which can be operably coupled to themotor. The collet shaft 308 can include a rotation-limiting shape, suchas at least one flat surface. In some embodiments, such as shown inFIGS. 3A and 3B, the rotation limiting shape can include two opposingflat surfaces 309. When the collet shaft 308 engages the drive shaft,rotation of the drive shaft causes rotation of the collet shaft 308.

A distal end of the collet shaft 308 can be coupled to a first shaft208. As shown in FIGS. 3A and 3B, the distal end of the collet shaft 308can include a recess configured to fixedly (e.g., via friction,adhesives, or otherwise) receive the first shaft 208. In someembodiments, the collet shaft 308 and the first shaft 208 can be fixedlyengaged by other attachment features and/or mechanisms. As will bedescribed below, the first shaft 208 is configured to transmit arotation of the collet shaft 308 and/or torque to the driver head, suchas the driver head 300.

The first shaft 208 can be positioned inside and/or extend through thelumen of the elongate outer housing 202. A distal portion of the firstshaft 208 can extend distally from the elongate outer housing 202 andinto an articulating torque transmission unit 210, such as a bevel gearassembly. The articulation unit can be located distally from theelongate outer housing 202. The articulating torque transmission unit210 can include an output shaft 214 fixedly coupled to a driver headadapter 212 (e.g., via a press fit pin 216 extending through a pin holein a distal portion of the output shaft 214 and a pin hole 218 on theadapter 212, or otherwise). As described below with reference to FIGS.4A to 5F, the articulating torque transmission unit 210 is configured totransmit rotation of the shaft 208 and/or torque to the driver headadapter 212.

The driver head adapter 212 can be configured to removably receive adriver head 400, such as a bit (e.g., a flat-head bit, Philips bit, hexbit, star bit, or otherwise). In some embodiments, such as shown inFIGS. 3D and 3E, the adapter 212 can include a generally square opening220 configured to receive a driver head having a shaft with a generallysquare cross-section. In certain embodiments, the driver head adapter212 can include an opening of a different shape that is complementary tothe shape of the driver head shaft and that causes rotation of thedriver head adapter 212 to be transmitted to the driver head shaft. Asshown, the driver head adapter 212 can include a second opening 221 thathas a greater internal dimension than the square opening 220.

In various embodiments, a driver head shaft 402 can be retained in theadapter 212. For example, the driver head shaft 402 can be retained witha friction fit, detent mechanism, or otherwise. In some implementations,such as shown in FIG. 3F, the driver head shaft 402 of the driver head400 can include two or more opposing prongs 404 separated by a gap suchthat a distance between outer surfaces of the prongs 404 is greater thana width of the generally square opening 220. The prongs 404 can deflectslightly toward each other when inserted into the generally squareopening 220. The tendency of the prongs 404 to spring apart back to theoriginal gap size can aid in retaining the driver head shaft 304 insidethe square opening 220. In some embodiments, the prong 404 can have achamfer or tapering 406 at its free end to facilitate insertion of theprongs 404 into the generally square opening 220. The prongs 404 of thedriver head shaft 402 can expand after the driver head shaft 402advances past the square opening 220 into the second opening 221, whichcan aid in retaining the driver head shaft 402 within the driver headadapter 212. In some embodiments, the shaft of the driver head caninclude other types of retaining mechanism(s), such as spring-biasedball detent or others, so that the second opening 221 can retain thedriver head shaft when the driver head shaft advances past the squareopening 220 into the second opening 221. In various embodiments, theadapter 212 and driver head shaft 402 are spaced apart from the proximalend of the tool 200 and/or the handpiece 10, such as by at least about:100 mm, 150 mm, 200 mm, 250 mm, or more.

As shown in FIG. 4A, the articulating torque transmission unit 210 caninclude a first bevel gear 226 fixedly coupled to the first shaft 208, asecond bevel gear 228 fixedly coupled to a gear support shaft 224, andthird bevel gear 230 fixedly coupled to the output shaft 214. The firstbevel gear 226 interacts with the second bevel gear 228. The secondbevel gear 228 interacts with the third bevel gear 230. In someembodiments, the bevel gears can include a metal, such as 440C stainlesssteel or otherwise. In certain embodiments, the gears can have aRockwell hardness of at least about 60-65 C. As shown in FIGS. 2 and 3A,the articulating torque transmission unit 210 can include one or moresupport walls 232, which can protect the bevel gears and/or the shaftsfrom external impacts.

As shown in FIG. 4B, as the first bevel gear 226 and the first shaft 208rotate in a first direction (e.g., counterclockwise), the second bevelgear 228 and the gear support shaft 224 rotate in a second directionperpendicular to the first direction (e.g., to the right as indicated inthe figure). The rotation of the second bevel gear 228 causes the thirdbevel gear 230 and the output shaft 214 to rotate in a third directionthat is opposite the first direction (e.g., clockwise). In variousembodiments, an axis of rotation of the second bevel gear 228 isgenerally perpendicular to an axis of rotation of the first and/or thirdbevel gear 226, 230. In certain implementations, the axes of rotation ofthe first and third bevel gears 226, 230 are generally parallel and/orcollinear when the driver head is not articulated.

In some embodiments, the fastening tool can include an articulation unit211 such as shown in FIG. 5A. The articulation unit 211 can include afirst bevel gear 226 fixedly coupled to the first shaft 208, a secondbevel gear 228 and a third bevel gear 229 fixedly coupled to two ends ofa gear support shaft 224, and a fourth bevel gear 230 fixedly coupled tothe output shaft 214. The first bevel gear 226 interacts with the secondbevel gear 228. Rotation of the second bevel gear 228 is transmitted tothe third bevel gear 229 via the gear support shaft 224. The third bevelgear 229 interacts with the fourth bevel gear 230. FIGS. 5B-5E showschematic illustrations of the articulating torque transmission unit 210with four bevel gears, such as shown in FIG. 5A.

In some embodiments, such as shown in FIG. 5F, as the first bevel gear226 and the first shaft 208 rotate in a first direction (e.g.,counterclockwise), the second bevel gear 228, the gear support shaft224, and the third bevel gear 229 rotate in a second directionperpendicular to the first direction (e.g., to the left). The rotationof the third bevel gear 229 causes the fourth bevel gear 230 and theoutput shaft 214 to rotate in the same direction as the first direction(e.g., counterclockwise).

The articulating torque transmission unit 210 in FIGS. 4A-4B and 5A-5Fcan allow for improved ranges of motion, such as between the first gear226 and the third gear 230 in the embodiment shown in FIGS. 4A-4B andbetween the first gear 226 and the fourth gear 230 in the embodimentshown in FIGS. 5B-5D. An embodiment of the articulating torquetransmission unit 210 with four bevel gears, such as shown in FIGS.5A-5F, can advantageously allow the rotation of the output shaft 224 tobe in the same direction as the first shaft 208. For example, inputrotation in a direction from the handpiece 10 can result in outputrotation in the same direction at the driver head 400.

An embodiment of the articulating torque transmission unit 210 withthree bevel gears, such as shown in FIGS. 4A-4B, can result in therotation of the output shaft 224 being reversed relative to the rotationof the first shaft 208. Having the output shaft 224 rotate in theopposite direction from the first shaft 208 may be confusing to a user.For example, a user may become familiar with a certain button thatcauses the articulating tool 1 to output clockwise rotation, so the usermay be confused when, after the tool 200 is connected, the articulatingtool 1 outputs counterclockwise rotation. Some embodiments areconfigured to automatically adapt to accommodate for the rotationreversal. For example, the handpiece 10 can reverse the drive directionof the motor for the button in response to the tool 200 being connectedto the handpiece 10. In some variants, the button drives the handpiecedrive shaft in a first direction (e.g., clockwise) before the tool 200is connected to the handpiece 10 and, after the tool 200 is connected tothe handpiece 10, the button drives the handpiece drive shaft in asecond direction (e.g., counterclockwise), which in turn causes thedriver head 300 to rotate in the first direction (e.g., clockwise). Thereversal can be performed through software on a controller of thehandpiece 10. The reversal can occur automatically in response toconnection of the tool 200 and/or can be invisible to the user.

Various embodiments include an articulation mechanism. In someembodiments, such as shown in FIG. 6A, the articulation mechanismincludes a second shaft 234. The shaft 234 can be positioned insideand/or extend through the lumen of the elongate outer housing 202. Thesecond shaft 234 can run generally parallel to the first shaft 208. Aproximal portion of the second shaft 234 can include a rotationlimitation feature 236 (e.g., one or more flat surfaces). The proximalportion of the second shaft 234 can extend through an opening of astopper 238 that is located distally from and near a distal end of thecollet housing 302. The opening of the stopper 238 that engages theproximal portion of the second shaft 234 can have a shape generallycomplementary to the rotation limitation feature 236. The stopper 238can be fixedly attached to the distal end of the collet housing 302 suchas the second shaft 234 is prevented substantially from rotationalmovements.

In some embodiments, at least part of the proximal portion of the secondshaft 234 can include helical threads (e.g., external threads). Anactuator (such as a wheel 240, a worm gear, or otherwise) can includecorresponding helical threads (e.g., internal threads or externalthreads) that engage the threads on the second shaft 234. As the secondshaft 234 is substantially prevented from rotational movements due tothe engagement between the rotation limitation feature 236 and thestopper 238, rotating the wheel 240 can cause axial movements of thesecond shaft 234. Rotating the wheel 240 in one direction can cause thesecond shaft 234 to advance distally toward the driver head adapter 212.Rotating the wheel 240 in the opposite direction can cause the secondshaft 234 to retract proximally away from the driver head adapter 212.

A distal portion of the second shaft 234 can extend distally from theelongate outer housing 202 and into the articulating torque transmissionunit 210. A linkage arm 242 can be coupled to a distal end of the secondshaft 234 at a hinge 244. As shown in FIGS. 6A and 6B, the support walls232 of the articulating torque transmission unit 210 can include a gapconfigured to slidably engage the second shaft 234 and the linkage arm242. An end of the linkage arm 242 that is opposite the end coupled tothe hinge 244 can be pivotally coupled to the support walls 232 (e.g.,via a pivot pin extending generally transversely through the supportwalls and the linkage arm 242).

As shown in FIGS. 7A and 7B, the adapter 212 and/or the driver head 300can be articulated relative to the housing 202. In some implementations,the articulation occurs as a result of movement of the second shaft 234,such due to rotation of the wheel 240 and the threaded engagement of thewheel 240 and the second shaft 234. As shown, proximal movement of thesecond shaft 234 (e.g., relative to housing 202 and/or wheel 240) cancause the linkage arm 242 to bend at the hinge 244 and rotate relativeto the second shaft 234. The support walls 232 can include proximal anddistal portions 245, 247 pivotally coupled at a second hinge 246, whichis coupled to the gear support shaft 224. The distal portion 247 can befixedly coupled to the output shaft 214. The bending of the linkage arm242 can cause the distal portion 247, the driver head adapter 212 (andthe driver head 300 coupled to the adapter 212) to pivotally rotateabout the second hinge 246 and/or the gear support shaft 224. Tostraighten the linkage arm 242 relative to the second shaft 234, such asshown in FIG. 6A, the second shaft 234 can be moved distally, forexample, by rotating the wheel 240 in the opposite direction.

In various embodiments, the tool 200 can transmit rotation to the driverhead 300 while also being able to articulate, such as about the hinge246. The tool 200 can advantageously drive screws or other fasteners ina variety of positions. The tool 200 can adjust (e.g., bend or pivot) soas to access tight spaces and/or provide a desired orientation ofplacing and driving the fastener. In various embodiments the mechanismthat controls the articulation of the tool is separate (e.g.,independently operable) from the mechanism that transmits torque todrive the screws or other fasteners. In some variants, the mechanismthat controls the articulation and the mechanism that transmits torqueto the driver head can each include a distinct shaft and/or a distinctcontrol device (e.g., actuator). For example, the mechanism thatcontrols the articulation can include the second shaft 234 and/or thewheel 240, and the mechanism that transmits torque to the driver headcan include the first shaft 208 and/or one or more buttons on thehandpiece 10.

Other Embodiments of an Articulating Fastening Tool

Any of features of the embodiments described below can be incorporatedinto the fastening tool 200 described above.

In some embodiments, such as shown in FIG. 8, the Input Shaft (1) isrigidly connected to Gear ‘X’; the Idler Shaft (3) is rigidly connectedto Gear ‘A’ (Gear ‘A’ is a double sided Bevel Gear); and the OutputShaft (2) is rigidly connected to Gear ‘Z’. Gear ‘X’ interfaces withGear ‘A’. Gear ‘A’ also interfaces with Gear ‘Z’. As Gear ‘X’ rotatesCCW, Gear ‘A’ rotates to the Left, which causes Gear ‘Z’ to rotate CCW.An advantage of this arrangement is the increased articulation that canbe achieved.

Some embodiments are configured to articulate the driver head adapter,(such as past about 45° or about 90°, without the bevel gears directlywith one another. In some embodiments, such as shown in FIG. 9, aarticulation unit of an articulating fastening tool can include a chainor belt 950. The belt 950 can extend the point from with the motion istransferred from one set of bevel gears to the set of bevel gears. Aninput shaft 956 can act on a set of bevel gears 952, one of which can berigidly connected to a belt pulley or chain cog 954. The belt 950 can beconnected to a second belt pulley or chain cog 958, which can beconnected to a second set of bevel gears 960, one of which acts on anoutput shaft 962. An advantage of this design is the motion transferbetween the input and output bevel gears 952, 960 is effectivelyrepositioned so that the articulating bevel gear will not interfere withthe other gearing.

In some embodiments, such as shown in FIGS. 10A-10E, the addition ofspur gears 1064 can transfer the motion of the input shaft 1056 to thearticulating output shaft 1062. This has a similar effect to the beltand/or chain system discussed above, but does so using additional gearsto move the bevel gears into a more effective location. Multiple gears(e.g., two, three, or more) can be added to further displace (e.g.,space apart) the bevel gears, if needed. An advantage of this design isthe motion transfer between the input and output bevel gears can berepositioned so that the articulating bevel gear does not interfere withthe other gearing.

In some embodiments, the fastening tool can include bevel gears such asshown in FIG. 11. Gear A can be coupled to the drive shaft. Rotation ofGear A gets transferred, via Idler Gear B, to Gear C, which can becoupled to the output shaft to drive the screws. At the same time, GearC is free to re-orient in 3 dimensions. Some implementations can includea gear reduction or speed multiplication through the idler gear.

In some embodiments, such as shown in FIG. 12, other configurations ofbevel gears can transfer the rotation through the articulating joint. Inthe configuration shown in FIG. 11, Gear A can constrain (e.g., due to aphysical interference) the rotation of Gear C. In contrast, in the bevelgear mechanism such as shown in FIG. 12, Gears A and B are arrangedsymmetrically about the Idler Gear B. As the planes of articulation nolonger intersect, the mechanism in FIG. 12 can allow for an increasedrange of motion compared to, for example, the mechanism in FIG. 11.

In some embodiments, such as shown in FIG. 13, the tip of the driverhead adapter can be substantially collinear with the drive axis of aninput shaft 1356. The bevel gear mechanism in FIG. 12 introduces anoffset. Certain embodiments, such as shown in FIG. 13, the gearmechanism of FIG. 12 can be connected to a spur gear 1364 to adjust theoffset. As shown, tip of the driver head adapter 1312 can besubstantially collinear with the tip of the input shaft 1356.

Various embodiments of an articulating fastening tool can be configuredto control the orientation of the driver head adapter 212 at a locationaway from the driver head adapter 212 and/or closer to the handpiece 10.Some embodiments, such as shown in FIG. 14, can include a worm gear 1466acting on a gear or adapter adjustment dial 1468. The adjustment dial1468 can serve as a user interface (e.g., located near a proximal end ofthe fastening tool or on the handpiece). Rotating the adjustment dial1468 can articulate (e.g., open or close) the mechanical linkage on theleft side of the adjustment dial 1468 (e.g., from about 0° to about)90°. In certain embodiments, the linkage can translate rotational motionabout the shaft axis to an axis generally perpendicular to the shaftaxis and about which the driver head can rotate or articulate. In somevariants, rotation of the adapter adjust dial 1468 can rotate the wormgear 1466 and the driver head adapter accordingly.

Some embodiments can have a stationary cam or pin 1570 such as shown inFIG. 15, for articulating the driver head adapter and/or the driverhead. Gear B and the cam or pin 1570 are mounted to the same shaft oraxis, but are free to rotate independently of one another. The cam orpin 1570 is connected to the shaft, while Gear B has a bearing thatallows Gear B to rotate independently of the shaft. The center of Gear Cis fixed to the end of the cam or pin 1570. The cam or pin 1570 canprotrude into the moveable output bevel gear (such as Gear C describedabove), but does not rotate with respect to the rotation of the moveableoutput bevel gear. When the cam or pin 1570 is rotated about theconnected shaft, Gear C can rotate with the cam or pin 1570 along thesurface of Gear B. However, the cam or pin 1570 is fixed to the centerof Gear C such that Gear C is free to spin about the center axis of theshaft. The cam or pin 1570 can be actuated via a rod sliding back andforth similar to the rod 1674 in FIG. 16. A gear similar to the gear1678 but smaller in size can connect to the shaft to which the cam orpin 1570 is mounted to.

Certain implementations can use mechanical linkages that are activatedby a rod that pushes and pulls on the adapter, for example, such asshown in FIG. 16. The rod can be activated by advancing the adjustmentdial on a threaded track. Some embodiments, such as shown in FIG. 16,can have a swash plate 1672 (or angled plate). The swash plate 1672 canbe angled relative to the longitudinal axis of the tool 200. The swashplate 1672 can be configured to abut against and/or articulate thedriver head adapter 212 and/or the driver head 300. In some embodiments,the swash plate 1672 acts against a push rod 1674. For example, theswash plate 1672 can rotate relative to the push rod 1674, which due tothe angle of the swash plate 1672, causes the push rod 1674 to movelongitudinally. In implementations, the push rod 1674 translates a rackgear 1676, which activates a gear 1678 that is used to control theorientation of the driver head adapter 212 and/or the driver head 300.In some embodiments, the shaft 208 extends through the swash plate 1672and/or can rotate relative to the swash plate 1672.

Several embodiments of the fastening tool can enable the input shaft tobe rotated 360°. In some embodiments, the 360° rotation of the inputshaft is achieved by retracting the pins allowing for discrete rotationof the driver head adapter with respect to the driver unit. In someembodiments, rotation of the input shaft is achieved with a friction fitbetween the input shaft and the body interface (e.g., the housing 202)so that the input shaft can be manually rotated to the desiredorientation. In some embodiments, such as shown in FIG. 17, the 360°rotation of the input shaft 1756 can be achieved by utilizing a geartype system by which an adjustment dial 1770 (e.g., in a directionperpendicular to the rotation of the input shaft 1756) can be used torotate a gear 1772. The gear 1772 can control the orientation of theshaft 1756 with respect to the driver unit. In the embodiments such asshown in FIG. 17, the driver head can stay fixed to the fastening toolas the gear 1772 is rotated to rotate the driver head.

Certain Terminology

Terms of orientation used herein, such as “top,” “bottom,” “horizontal,”“vertical,” “longitudinal,” “lateral,” and “end” are used in the contextof the illustrated embodiment. However, the present disclosure shouldnot be limited to the illustrated orientation. Indeed, otherorientations are possible and are within the scope of this disclosure.Terms relating to circular shapes as used herein, such as diameter orradius, should be understood not to require perfect circular structures,but rather should be applied to any suitable structure with across-sectional region that can be measured from side-to-side. Termsrelating to shapes generally, such as “circular” or “cylindrical” or“semi-circular” or “semi-cylindrical” or any related or similar terms,are not required to conform strictly to the mathematical definitions ofcircles or cylinders or other structures, but can encompass structuresthat are reasonably close approximations.

Conditional language, such as “can,” “could,” “might,” or “may,” unlessspecifically stated otherwise, or otherwise understood within thecontext as used, is generally intended to convey that certainembodiments include, while other embodiments do not include, certainfeatures, elements, and/or steps. Thus, such conditional language is notgenerally intended to imply that features, elements, and/or steps are inany way required for one or more embodiments or that one or moreembodiments necessarily include logic for deciding, with or without userinput or prompting, whether these features, elements, and/or steps areincluded or are to be performed in any particular embodiment.

The terms “approximately,” “about,” and “substantially” as used hereinrepresent an amount close to the stated amount that still performs adesired function or achieves a desired result. For example, in someembodiments, as the context may permit, the terms “approximately”,“about”, and “substantially” may refer to an amount that is within lessthan or equal to 10% of the stated amount. The term “generally” as usedherein represents a value, amount, or characteristic that predominantlyincludes or tends toward a particular value, amount, or characteristic.As an example, in certain embodiments, as the context may permit, theterm “generally parallel” can refer to something that departs fromexactly parallel by less than or equal to 15 degrees. As anotherexample, in certain embodiments, as the context may permit, the term“generally perpendicular” can refer to something that departs fromexactly perpendicular by less than or equal to 15 degrees.

CONCLUSION

While a number of variations of the disclosure have been shown anddescribed in detail, other modifications, which are within the scope ofthis disclosure, will be readily apparent to those of skill in the artbased upon this disclosure. For example, although several embodimentsare discussed above with bevel gears, other types of gears (e.g., spurgears, spline gears, spiral bevel gears, miter gears, helical gears,etc.) and other torque transmission devices are contemplated. It is alsocontemplated that various combinations or sub-combinations of thespecific features and aspects of the embodiments may be made and stillfall within the scope of the disclosure. Accordingly, it should beunderstood that various features and aspects of the disclosedembodiments can be combined with or substituted for one another in orderto form varying modes of the disclosed.

Furthermore, certain features that are described in this disclosure inthe context of separate implementations can also be implemented incombination in a single implementation. Conversely, various featuresthat are described in the context of a single implementation can also beimplemented in multiple implementations separately or in any suitablesubcombination. Moreover, although features may be described above asacting in certain combinations, one or more features from a claimedcombination can, in some cases, be excised from the combination, and thecombination may be claimed as a subcombination or variation of asubcombination.

Features, materials, characteristics, or groups described in conjunctionwith a particular aspect, embodiment, or example are to be understood tobe applicable to any other aspect, embodiment or example described inthis section or elsewhere in this specification unless incompatibletherewith. All of the features disclosed in this specification(including any accompanying claims, abstract and drawings) may becombined in any combination, except combinations where at least some ofsuch features and/or steps are mutually exclusive. The protection is notrestricted to the details of any foregoing embodiments. The protectionextends to any novel one, or any novel combination, of the featuresdisclosed in this specification (including any accompanying claims,abstract and drawings), or to any novel one, or any novel combination sodisclosed.

For purposes of this disclosure, certain aspects, advantages, and novelfeatures are described herein. Not necessarily all such advantages maybe achieved in accordance with any particular embodiment. Thus, forexample, those skilled in the art will recognize that the disclosure maybe embodied or carried out in a manner that achieves one advantage or agroup of advantages as taught herein without necessarily achieving otheradvantages as may be taught or suggested herein.

Some embodiments have been described in connection with the accompanyingdrawings. The figures are drawn to scale where appropriate, but suchscale should not be limiting, since dimensions and proportions otherthan what are shown are contemplated and are within the scope of thedisclosed invention. Distances, angles, etc. are merely illustrative anddo not necessarily bear an exact relationship to actual dimensions andlayout of the devices illustrated. Components can be added, removed,and/or rearranged. Further, the disclosure herein of any particularfeature, aspect, method, property, characteristic, quality, attribute,element, or the like in connection with various embodiments can be usedin all other embodiments set forth herein. Additionally, any methodsdescribed herein may be practiced using any device suitable forperforming the recited steps.

Although this invention has been disclosed in the context of certainembodiments and examples, the scope of this disclosure extends beyondthe specifically disclosed embodiments to other alternative embodimentsand/or uses of the invention and obvious modifications and equivalentsthereof. Any system, method, and device described in this applicationcan include any combination of the preceding features described in thisand other paragraphs, among other features and combinations describedherein, including features and combinations described in subsequentparagraphs. While several variations of the invention have been shownand described in detail, other modifications, which are within the scopeof this invention, will be readily apparent to those of skill in the artbased upon this disclosure. It is also contemplated that variouscombinations or sub-combinations of the specific features and aspects ofthe embodiments may be made and still fall within the scope of theinvention. Various features and aspects of the disclosed embodiments canbe combined with, or substituted for, one another in order to formvarying modes of the disclosed invention. Thus, it is intended that thescope of the present invention herein disclosed should not be limited bythe particular disclosed embodiments described above, but should bedetermined only by a fair reading of the claims that follow.

1. (canceled)
 2. An offset tool for use with a drive mechanism during asurgical procedure, the offset tool comprising: an elongate outerhousing comprising a lumen and a longitudinal axis, wherein the elongateouter housing is configured to rotate around the longitudinal axis; anoffset torque transmission mechanism connected to the elongate outerhousing, the offset torque transmission mechanism comprising: a firstshaft within the lumen of the elongate outer housing; an articulatingtorque transmission unit having: a first end that is coupled to a distalportion of the first shaft; and a second end that is not collinear withthe first end and that comprises a driver head adapter, the driver headadapter configured to removably engage with a bit and to rotate the bitaround a bit axis; wherein the offset torque transmission mechanism isconfigured to transmit torque from the drive mechanism to the driverhead adapter and the bit; and an orientation mechanism that is separatefrom the offset torque transmission mechanism, the orientation mechanismcomprising: a second shaft within the lumen of the elongate outerhousing; and a controller configured to rotate the second shaft; whereina proximal portion of the second shaft is connected to the controller;wherein a distal portion of the second shaft is connected to the driverhead adapter; and wherein rotation of the second shaft rotates thedriver head adapter around a transverse axis that is generallyperpendicular to the longitudinal axis.
 3. The offset tool of claim 2,wherein the articulating torque transmission unit comprises first,second, and third bevel gears, wherein the first bevel gear is fixedlycoupled to the first shaft, the second bevel gear is coupled to a gearsupport shaft, and the third bevel gear is coupled to the driver headadapter.
 4. The offset tool of claim 3, wherein the second bevel gear isbetween the longitudinal axis and the bit axis.
 5. The offset tool ofclaim 3, wherein the first bevel gear intersects with the second gearand the second gear intersects with the third gear.
 6. The offset toolof claim 2, wherein the articulating torque transmission unit comprisesfirst, second, third, and fourth bevel gears, wherein the first bevelgear is fixedly coupled to the first shaft, the second and third bevelgears are coupled to a gear support shaft, and the fourth bevel gear iscoupled to the driver head adapter.
 7. The offset tool of claim 6,wherein the second and third bevel gears are between the longitudinalaxis and the bit axis.
 8. The offset tool of claim 6, wherein the firstbevel gear intersects with the second bevel gear and the third bevelgear intersects with the fourth bevel gear, and wherein rotation of thesecond bevel gear is transmitted via the gear support shaft to rotationof the third bevel gear.
 9. The offset tool of claim 2, wherein thedriver head adapter comprises a lumen configured to receive a shaft ofthe bit.
 10. The offset tool of claim 9, wherein the driver head adapteris coupled to the shaft of the bit via a quick-release mechanism. 11.The offset tool of claim 2, wherein the drive mechanism comprises anelectric motor.
 12. The offset tool of claim 2, wherein the elongateouter housing is configured to rotate relative to the drive mechanismbetween about 0° to about 360°.
 13. The offset tool of claim 2, whereinthe driver head adapter is configured to rotate around the transverseaxis between about 0° to about 360°.
 14. The offset tool of claim 2,wherein the controller comprises a wheel, wherein rotation of the wheelcauses the second shaft to rotate.
 15. An articulating tool for drivinga fastener into a bone during a surgical procedure, the articulatingtool comprising: an elongate outer housing comprising a proximal end, adistal end, a lumen, and a longitudinal axis, the elongate outer housingconfigured to engage with a handpiece comprising a drive mechanism; atorque transmission mechanism comprising: a first shaft that extendsthrough the lumen of the elongate outer housing; an articulating torquetransmission unit comprising: a first end comprising a first set ofgears, wherein the first end is coupled to a distal portion of the firstshaft; and a second end that is configured to articulate relative to thefirst end, the second end comprising a second set of gears, wherein atleast one of the second set of gears intersects at least one of thefirst set of gears; and a driver head adapter that is positioned at thesecond end of the articulating torque transmission unit, the driver headadapter configured to removably engage with a bit and to rotate the bitaround a bit axis, the bit configured to engage with the fastener;wherein the torque transmission mechanism is configured to transmittorque from the drive mechanism to the driver head adapter and the bit,thereby driving the fastener engaged with the bit into the bone; and anorientation mechanism that is separate from the torque transmissionmechanism, the orientation mechanism comprising: a second shaftextending through the lumen of the elongate outer housing; and anactuator connected to a proximal portion of the second shaft, theactuator configured to move the second shaft proximally and distallywherein: in response to movement of the second shaft, the second set ofgears rotate about a central axis of the first set of gears such thatthe driver head adapter rotates around a transverse axis, wherein thetransverse axis is generally perpendicular to the longitudinal axis. 16.The articulating tool of claim 15, wherein the driver head adapter isconfigured to rotate the bit in a same direction as the first shaft. 17.The articulating tool of claim 15, wherein the elongate outer housingfurther comprises a body coupling assembly that is configured toreleasably couple to the handpiece.
 18. The articulating tool of claim17, wherein the body coupling assembly comprises of a quick-releasemechanism, wherein the quick-release mechanism further comprises oforientation features to facilitate aligning the handpiece with the bodycoupling assembly.
 19. The articulating tool of claim 15, wherein theactuator comprises a wheel, wherein rotation of the wheel causes axialmovements of the second shaft.
 20. An articulating tool for use with adrive mechanism during a surgical procedure, the articulating toolcomprising: an elongate outer housing comprising a proximal end, adistal end, a lumen, and a longitudinal axis, wherein the elongate outerhousing is configured to rotate around the longitudinal axis; a torquetransmission mechanism comprising: a first shaft that extends throughthe lumen of the elongate outer housing; an articulating torquetransmission unit comprising: a first end comprising a first gear,wherein the first end is coupled to a distal portion of the first shaft;and a second end comprising a second gear, wherein the second gearintersects the first gear; and a driver head adapter that is positionedat the second end of the articulating torque transmission unit, thedriver head adapter configured to removably engage with a bit and torotate the bit around a bit axis; wherein the torque transmissionmechanism is configured to transmit torque from the drive mechanism tothe driver head adapter and the bit, and wherein rotating the elongateouter housing rotates the torque transmission mechanism around thelongitudinal axis; and an orientation mechanism that is separate fromthe torque transmission mechanism, the orientation mechanism comprising:a second shaft extending along the elongate outer housing; and anactuator connected to a proximal portion of the second shaft, theactuator configured to move the second shaft proximally and distallywherein: in response to movement of the second shaft in a firstdirection, the second gear rotates about a central axis of the firstgear such that an angle between the longitudinal axis and the bit axisincreases; and in response to movement of the second shaft in a seconddirection, the second gear rotates about the central axis of the firstgear such that the angle between the longitudinal axis and the bit axisdecreases.
 21. The articulating tool of claim 20, wherein thearticulating torque transmission unit comprises a first bevel gear and asecond bevel gear, wherein the first bevel gear is fixedly coupled tothe first shaft and intersects the first gear, the second bevel gear iscoupled to the driver head adapter and intersects the second gear.